The Centers for Medicare & Medicaid Services (CMS) first introduced the targeted probe and educate (TPE) process in 2014 and its use has grown exponentially since that time. CMS promotes the process as a way to lessen the audit burden on hospitals that are following the rules by targeting those providers whose data stands out as an outlier. As time as gone by, CMS and the Medicare Administrative Contractors (MACs) have expanded the topics subject to audit to include post-acute care. This means that more and more providers may be dependent on the documentation of others to support their claims.
In this exclusive RACmonitor webcast, Dr. Ronald Hirsch will briefly review the TPE process, the important deadlines for providers, and tips for medical record preparation and victory during the discussion period. He will then review current targets of the audits and provide sensible solutions to avoid being selected for audit and to fight denials and win audits if selected.
The use of TPE by CMS and the Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) as a method of ensuring hospital adherence to the two-midnight rule has provided a deep understanding of the process and will also be reviewed with lessons learned by hospitals that have been audited.
At the end of the webcast, you will have an understanding of the actions needed to ensure the probe and educate process passes them by without a glance.
Why This is Relevant:
TPE audits are growing, and the results are not encouraging. Many providers are being sent on the second round with severe consequences if they do not do well. By not attending this webcast, you risk being blindsided with an audit that you should have seen coming. Moreover, the cost to defend one denial exceeds the cost of this webcast. If you avoid two denials, you'd made 100 percent on your investment. And it grows from there.
During this exclusive RACmonitor webcast with Dr. Hirsch, you will…
- Understand the TPE process
- Review the documentation requirements of TPE
- Develop audit avoidance methods
- Prepare for TPE discussions with the auditors
- Predict future TPE targets